When should we place a Midline instead of a PICC line? Midlines are lines that are 20cm in length, the tip terminates in the upper arm and can remain in for about 10 days. The patients that benefit the most from Midlines are those that we call “difficult sticks”, they can have diagnosis of dehydration, COPD, CHF and short term IV abx needs. This line is placed by PICC trained nurses, but can be taught to all nurses. Care and maintenance is the same as a PICC line, but the big difference is the tip is not central and the patient is at less risk for CR-BSI’s (catheter related blood stream infections). When assessing the patient for the best line for their therapy and needs, we should also consider this line. It takes less time to insert, complications are less, and it prevents multiple needle sticks in the patient with difficult access.
"The most common procedure conducted in hospitals is the placement of peripheral intravenous (PIV) catheters". Prior to 2011, routine PIV catheter replacement was recommended as "standard of care" 14; however, in 2011 an evidence-based CDC guideline 15 modified their recommendation regarding PIV standard of care, and leading societies subsequently modified their own recommendations on appropriate PIV management. The CDC and the Infusion Nurses Society (INS) have released evidence-based guideline changes indicating the longer dwell times for PIV catheters may be acceptable. 15,16" from Peripheral IV Executive Monograph, Protect all lines. Protect All Lives. ™ Ethicon, Inc, 2013. As nurses who want to provide the best care for our patients, we want to incorporate this evidence safely and protect our patients at all costs. BioPatch is a product we know and trust. We place it on insertion sites for Midline and PICC catheters, CVC's and Ports, so why not use it on PIV insertion sites? We will be conducting a trial at Stoughton Hospital with this product. We will be posting and blogging about our results weekly.